New Provider Network Publication

The Provider-LME/MCO Steering Committee was created in the Spring of 2013 and is an independent body composed of LME-MCO, large provider organization, and statewide association representatives. This group evolved in response to the need for a venue in which business practices between MCOs and providers could be addressed with the goal of increasing standardization through the identification and resolution of barriers to successful business operations. To achieve these goals, the IT and Business Practices Subcommittees were created under the auspices of that committee. The Steering Committee is pleased to announce the following standardization activities that will be implemented in the next few months. Smoky Mountain LME/MCO will be implementing these changes as endorsed by the Steering Committee.

Click link to read about the changes.

Effective August 1, 2014, Smoky will begin sending written notices of administrative denials of Medicaid authorization requests to consumers or their guardians.  Providers will be sent copies of these notices.  As with clinical denials of services, consumers, but not providers, have the right to request Reconsideration (first level appeal) of administrative denials of service requests.  These notices and appeal rights do not apply to non-Medicaid or to Medicaid B3 services.

Administrative denials are issued when required information (e.g., a Service Order or a LOCUS or CALOCUS score) is not submitted with Service Authorization Requests (SARs).

You can help prevent administrative denials by ensuring that all required information and documentation is provided when submitting service authorization requests (SARs), and by responding promptly when contacted by a Care Manager or Care Reviewer to address missing information.

When administrative denials do occur, please address and resolve the problem promptly in one of the following ways:

1.   Submit a new SAR with all required supporting documentation including what was missing in the original submission.  If the service is determined to be medically necessary, and if all required information is submitted, the effective date of the service will be on or after the submission date of the new SAR.

2.   Submit the missing information and work with the consumer to submit a request for Reconsideration of the administrative denial.  If the service is determined to be medically necessary, and if all required information is submitted, the denial will be reversed effective the date that the required information is received by Smoky.

For questions about administrative denials and appeals, please contact Steve Puckett, Clinical Support Director at stephen.puckett@smokymountaincenter.com or at (828) 586-5501, ext. 1232.

The VA Boston Healthcare System has launched a study using the latest research technology in human DNA analysis to help determine the underlying genetic variables responsible for schizophrenia.

See flyer to learn more about the study.

Thank you to our providers for joining with Smoky to improve our NC-TOPPS compliance rating. The topic for this week's Provider Communication is "How to run a report of updates needed." The information below is from the NC TOPPS Superuser Guide:

I need to know what updates are due for my agency. How do I find this?

1. Go to the NC-TOPPS main website (http://www.ncdhhs.gov/mhddsas/providers/NCTOPPS/) and click on the green folder "NC-TOPPS 2.1 Website."

2. Log in with your current NC-TOPPS username and password.

3. Click on the Locations tab to select an LME/MCO and provider agency name/address in the blue bar near the top of the page (it does not matter which one you choose). Once you choose a location, the Reports tab will appear to the right of the Website Submission tab.

4. Click on the Reports tab and then click on "Updates Needed." Here you will find the consumer record numbers that are currently due for an NC-TOPPS Update. You will see the "Interview Type Due" and "Date Due" to the far right of the screen (use the scroll bar at the bottom of the box to see this information). You will also find more information such as Provider Agency, Consumer information (DOB, Name Initials, Gender, Consumer Group), QP information (First Name, Last Name, and Username) and information for previous interviews for the consumer (Date Initial Started, Last Interview Type Submitted, Date Last Interview Type Started)

            5. If you want to print this list, click on "Print Report" at

            the bottom of the page. If you want to export this data, click on

            "Export Data" at the bottom of the page.      

The weekly schedule is a tool available for use  in plan development. The purpose of the schedule is to help determine what is important to/for an Innovations Waiver participant.  Natural and community supports should be scheduled first, along with the participant's interests and habits (when the individual prefers to eat, sleep, work, participate in leisure activities).  Paid supports should be built around natural supports. Schedules take into account many things such as when a person learns best and when they need breaks.  The weekly schedule should inform the ISP and budget. While the limits on sets of services restricts the number of service hours by the week, the schedule and ISP reflect the typical hours of service needed per day. There is flexibility around service delivery for non-routine deviations due to illness or unexpected events.

If there is to be a routine/ ongoing deviation to the schedule due to change in the participant's wants or needs, it is recommended that the team update the weekly schedule to reflect the change. Unless there is a change to the total number of hours per year, the updated schedule would not need to be submitted to or approved by Smoky I/DD Care Managers but would be  uploaded into the electronic record by the Care Coordinator.  Under no circumstances  should the schedule be amended based on the needs of the provider agency.  Once the schedule is established only changes initiated by the participant or legally responsible person (LRP) may occur . Post-payment reviews and routine monitoring reviews will audit deviations from the schedule and a Plan of Correction may be required. ** Clear notation on grids, services notes, or on a QP communication log regarding episodic changes at the participant's/LRP's request are evidence of adherence to the intent of the Innovations Waiver.

An original NC-SNAP assessment form must be used to complete all NC-SNAP for each individual. The NC-SNAP Assessment forms are available in PDF format and should not be altered in anyway.

The supplemental information sheet should be printed separately as a single page document. All completed NC-SNAP assessments MUST be accompanied by an NC-SNAP Supplemental Information Sheet.

All completed NC-SNAP assessments MUST be uploaded to Alpha then submitted to the LME/MCO for keying into the NC-SNAP data base. Send to Tammy.Harwood@smokymountaincenter.com or Mitzi.Bivens@smokymountaincenter.com

NC-SNAP information and forms may now be accessed via the DMH/DD/SAS web site at http://www.ncdhhs.gov/mhddsas/providers/NCSNAP/index.htm

Links to the updated NC SNAP manuals and forms can be found at the bottom of that page.